MEDICARE: DR. KIRK BRIAN JUHASZ D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN18647	FL

General Provider Information

NPI Number	:	1629204441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRK BRIAN JUHASZ D.M.D.

Provider Business Mailing Address
First Line	:	3510 NW 43RD ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6104
Country	:	US
Telephone Number	:	352-377-1705
Fax Number	:	352-377-1093

Provider Business Practice Location Address
First Line	:	3510 NW 43RD ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6104
Country	:	US
Telephone Number	:	352-377-1705
Fax Number	:	352-377-1093

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2009
Last Update Date	:	06/08/2009

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